Treatment of basal cell carcinomas at high risk for recurrence
- Sumaira Z Aasi, MD
Sumaira Z Aasi, MD
- Clinical Associate Professor, Department of Dermatology
- Stanford University School of Medicine
- Timothy K Chartier, MD
Timothy K Chartier, MD
- Associate Clinical Professor
- Yale University School of Medicine
- Department of Dermatology
- Section Editors
- June K Robinson, MD
June K Robinson, MD
- Section Editor — Nonmelanoma Skin Cancer
- Professor of Clinical Dermatology
- Northwestern University Feinberg School of Medicine
- Robert S Stern, MD
Robert S Stern, MD
- Section Editor — Nonmelanoma Skin Cancer
- Professor of Dermatology
- Harvard Medical School
Basal cell carcinoma (BCC) is a common skin cancer that arises from the basal layer of epidermis and its appendages. Treatment of BCC is indicated due to the locally invasive, aggressive, and destructive effects of BCC on skin and surrounding tissues (picture 1A-B).
Tumor characteristics such as size, location, and pathology influence the likelihood for deep tumor invasion and recurrence of BCC after treatment. Lesions at high risk for recurrence may benefit from removal with Mohs micrographic surgery, a procedure that allows for the assessment of all margins of excised tissue. Alternative therapies include conventional surgical excision and radiation therapy. Electrodessication and curettage (ED&C), cryosurgery, and topical 5-fluorouracil or imiquimod are not recommended for the management of these BCCs (table 1).
The treatment of BCCs with clinical or pathologic features associated with increased risk for recurrence will be reviewed here. The risk factors, clinical manifestations, and prognosis of BCC, as well as the management of less aggressive BCCs, are reviewed separately. (See "Epidemiology and clinical features of basal cell carcinoma" and "Treatment and prognosis of basal cell carcinoma".)
FEATURES ASSOCIATED WITH HIGH RISK FOR RECURRENCE
Certain clinical and pathologic features of basal cell carcinoma (BCC) are associated with an elevated risk for recurrence after treatment. Recurrent BCC may reappear months to years after initial treatment, leading to local tissue destruction, morbidity, increased risk for metastasis, and the need for retreatment (picture 1A-B). (See "Treatment and prognosis of basal cell carcinoma", section on 'Local recurrence' and "Treatment and prognosis of basal cell carcinoma", section on 'Metastasis'.)
The following characteristics have been proposed as factors associated with increased risk for tumor recurrence [1-3]:
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- FEATURES ASSOCIATED WITH HIGH RISK FOR RECURRENCE
- APPROACH TO TREATMENT
- Mohs surgery
- - Efficacy
- - Indications
- - Advantages and disadvantages
- Surgical excision
- Staged excision with circumferential margin assessment
- Radiation therapy
- - Results
- - Short-term effects of RT
- - Long-term complications
- - Patient selection
- Other therapies
- METASTATIC DISEASE
- PROGNOSIS AND FOLLOW-UP
- SUMMARY AND RECOMMENDATIONS